Restoration of partial edentulism aims to re-establish oral function with stable occlusion, acceptable esthetics, and adequate patient comfort. Among functional outcomes, maximum bite force and masticatory efficiency/performance are clinically meaningful because they reflect the patient’s ability to comminute food, maintain nutritional habits, and perform daily oral function with confidence. Tooth loss and subsequent prosthetic rehabilitation can substantially alter jaw muscle recruitment, occlusal contact pattern, and sensory feedback, which together influence masticatory performance and bite force generation [1,2]. While fixed prostheses are generally preferred over removable solutions for their stability, different fixed treatment modalities may not restore function to the same extent, particularly when periodontal support, abutment distribution, and proprioception differ between teeth and implants [3]. Conventional tooth-supported fixed partial dentures (FPDs) remain widely used in clinical practice. However, the requirement for preparation of adjacent teeth and the dependence on abutment tooth support are inherent limitations, especially in patients with intact neighboring teeth or compromised periodontal status. In contrast, implant-supported restorations can preserve tooth structure and provide fixed support without relying on natural abutments. Within implant options, single-piece (one-piece) implants integrate the implant body and transmucosal abutment into a single unit, potentially simplifying prosthetic steps and reducing microgap-related complications at the implant–abutment junction. Systematic evaluation of one-piece implant systems has reported high survival in appropriately selected cases, supporting their use as a predictable modality under controlled protocols [4]. Functional assessment in implant dentistry has evolved from subjective comfort alone to more standardized functional indices. Bite force measurement provides an objective proxy for masticatory muscle performance and occlusal stability and is frequently used to compare prosthetic modalities [5]. A related construct, masticatory efficiency/performance, can be assessed through several methods. Among contemporary clinical research tools, two-color chewing gum color-mixing tests have gained prominence because they are non-invasive, practical, and quantifiable. Schimmel and colleagues established and validated different analysis approaches for the two-color chewing gum test, providing a basis for standardized clinical evaluation [1]. Subsequent work has continued to refine and validate image-based analysis approaches and segmentation strategies for the color-mixing method, improving reproducibility and feasibility in clinical environments [6,7]. Despite growth in functional outcome research, direct clinical comparisons between single-piece implant-supported single crowns and conventional tooth-supported FPDs—specifically focusing on both bite force and masticatory efficiency using contemporary objective methods—remain limited. The clinician often must decide between preserving adjacent teeth with an implant solution versus providing a traditional bridge. This choice should be informed not only by survival and esthetics but also by measurable functional benefit [8-10]. Therefore, the present prospective comparative study evaluated bite force and masticatory efficiency in patients restored either with single-piece implant-supported crowns or conventional tooth-supported three-unit FPDs. We hypothesized that implant-restored patients would demonstrate superior functional outcomes at short-term follow-up due to improved occlusal stability and load-bearing capacity while maintaining acceptable patient-reported function [3,5].

Study design and setting A prospective, parallel-group clinical comparative study was conducted in a university-affiliated prosthodontic clinic. The study protocol followed ethical principles for research involving human participants, and informed consent was obtained from all participants prior to enrollment. Participants and eligibility Patients aged 20–55 years presenting with single-tooth bounded edentulous spaces in posterior regions (premolar/molar) were screened. Inclusion criteria were: (i) absence of active periodontal disease (probing depths ≤4 mm, no suppuration), (ii) adequate inter-arch space for fixed restoration, (iii) absence of uncontrolled systemic disease, (iv) no temporomandibular disorders or significant parafunctional habits reported, and (v) willingness to attend follow-up visits. Exclusion criteria included: pregnancy, neuromuscular disorders affecting mastication, uncontrolled diabetes, heavy smoking, severe malocclusion requiring orthodontic correction, and ongoing pain disorders. Group allocation and interventions Participants were enrolled into two groups based on the planned standard-of-care treatment after clinical and radiographic evaluation: • Group A (Single-piece implant group): Patients received a single-piece implant supporting a screw-retained or cement-retained single crown according to restorative plan and occlusal requirements. Implant placement and loading followed standard surgical and prosthetic protocols consistent with clinical guidance for one-piece implants [4]. • Group B (Conventional FPD group): Patients received a conventional tooth-supported three-unit fixed partial denture with prepared abutments and definitive cementation. Occlusion was adjusted to stable centric contacts and harmonious excursions. All participants received oral hygiene instructions and post-treatment care guidance. Outcome measures Primary outcomes were: 1. Maximum bite force (N): Measured at the first molar region on the rehabilitated side using a calibrated digital bite force transducer/gnathodynamometer. Three maximal voluntary clench readings were recorded with rest intervals; the highest value was used for analysis, consistent with clinical bite force measurement approaches reported in prosthodontic literature [5]. 2. Masticatory efficiency (color-mixing ability): Assessed using a two-color chewing gum test. Participants chewed a standardized two-colored gum for a fixed number of cycles; the sample was flattened and imaged for analysis. A validated approach derived from Schimmel et al. was used, producing a quantitative mixing index (e.g., variance of hue/VOH), where lower values indicate better mixing and thus better masticatory performance [1]. Methods aligned with subsequent methodological refinements for image-based assessment [6,7]. Secondary outcomes included a 10-cm visual analogue scale (VAS) for perceived chewing ability and a brief record of post-restorative complications requiring adjustment. Time points Measurements were taken at: • T0: within 1 week after definitive prosthesis delivery (baseline adaptation) • T1: 12 weeks after delivery (functional adaptation period) Statistical analysis Data were analyzed using standard statistical procedures. Normality was assessed by Shapiro–Wilk tests. Between-group comparisons at T0 and T1 were performed using independent t-tests (or Mann–Whitney U tests when appropriate). Within-group changes (T0 to T1) were tested using paired t-tests. Pearson correlation explored associations between bite force and masticatory efficiency indices. Statistical significance was set at p < 0.05.

A total of 60 participants completed the study (30 per group). No participant was lost to follow-up.Both groups were comparable at baseline with no statistically significant differences in age, sex distribution, prosthesis site (premolar vs molar), duration since tooth loss, or opposing dentition status. The similarity in baseline characteristics reduced confounding risk and supported the validity of subsequent functional comparisons. Most participants in both cohorts had natural opposing dentition, which was favorable for standardized functional testing and minimized variability from opposing removable prostheses or unstable occlusion (Table 1) Table 1. Baseline demographic and clinical characteristics Variable Group A: Single-piece implant (n=30) Group B: Conventional FPD (n=30) p-value Age (years), mean ± SD 34.7 ± 7.1 35.9 ± 6.8 0.52 Sex (Male/Female) 16 / 14 15 / 15 0.79 Site (Premolar/Molar) 12 / 18 11 / 19 0.79 Time since tooth loss (months), mean ± SD 10.8 ± 4.6 11.2 ± 4.9 0.74 Opposing dentition (Natural/Restored) 24 / 6 23 / 7 0.75 Maximum bite force increased significantly over 12 weeks in both groups, indicating functional adaptation after definitive rehabilitation. However, the implant group exhibited higher bite force at baseline and a substantially larger gain by 12 weeks. The between-group difference became more pronounced at follow-up, suggesting superior load-bearing performance and/or improved neuromuscular confidence during clenching on the implant-restored side. Clinically, this pattern indicates faster and greater functional recovery with single-piece implant-supported crowns compared with tooth-supported FPDs (Table 2). Table 2. Maximum bite force (N) at baseline and 12 weeks Time point Group A: Single-piece implant (n=30), mean ± SD Group B: Conventional FPD (n=30), mean ± SD Between-group p-value T0 (1 week post-delivery) 365.4 ± 88.6 312.1 ± 79.4 0.02 T1 (12 weeks) 463.8 ± 96.2 362.7 ± 83.1 <0.001 Within-group change (T1–T0) +98.4 ± 62.5 +50.6 ± 48.9 — Within-group p-value <0.001 <0.001 — Masticatory efficiency improved in both groups over 12 weeks, reflected by lower mixing index values at follow-up. The implant group demonstrated significantly better performance at both time points and achieved a lower mean mixing index by 12 weeks, consistent with more effective bolus comminution and mixing. While both restorations supported functional improvement, the magnitude of benefit and the final achieved efficiency favored single-piece implants, suggesting enhanced functional stability and more effective recruitment of chewing cycles after adaptation (Table 3). Table 3. Masticatory efficiency (two-color gum mixing index; lower = better) Time point Group A: Single-piece implant (n=30), mean ± SD Group B: Conventional FPD (n=30), mean ± SD Between-group p-value T0 mixing index 0.44 ± 0.09 0.49 ± 0.10 0.04 T1 mixing index 0.33 ± 0.08 0.41 ± 0.09 <0.001 Within-group change (T1–T0) −0.11 ± 0.07 −0.08 ± 0.06 — Within-group p-value <0.001 <0.001 — At 12 weeks, higher bite force was moderately associated with better masticatory efficiency (lower mixing index) in both cohorts, with a stronger correlation in the implant group. Patient-reported chewing ability improved over time in both groups, but the implant group reported higher mean VAS scores at follow-up, mirroring objective findings. Minor occlusal adjustments were required in a subset of participants in both groups, with no notable safety concerns or severe complications recorded during the observation period (Table 4). Table 4. Correlation between bite force and masticatory efficiency; patient-reported chewing VAS Outcome Group A: Single-piece implant (n=30) Group B: Conventional FPD (n=30) Correlation (Bite force vs mixing index) at T1, r (p) −0.58 (p=0.001) −0.41 (p=0.024) Chewing ability VAS (0–10) at T0, mean ± SD 6.8 ± 1.2 6.3 ± 1.3 Chewing ability VAS (0–10) at T1, mean ± SD 8.4 ± 1.0 7.5 ± 1.1 Common post-delivery adjustments (n, %) 6 (20.0%) 8 (26.7%)

This prospective clinical study demonstrated that both single-piece implant-supported crowns and conventional tooth-supported FPDs produced significant functional improvements over a 12-week adaptation period. However, patients restored with single-piece implants achieved higher maximum bite force and better masticatory efficiency than those restored with conventional FPDs, supporting the clinical relevance of treatment choice when functional outcomes are prioritized. The observed increase in bite force over time in both groups is consistent with the concept of post-restorative neuromuscular adaptation. Patients often demonstrate cautious loading soon after prosthesis delivery, followed by progressive improvement as occlusal comfort, confidence, and muscle recruitment normalize. Bite force has been discussed as both a functional endpoint and a biomechanical variable relevant to implant loading and prosthesis design, emphasizing that improved force generation can reflect functional rehabilitation while also highlighting the need for careful occlusal management to prevent overload [11]. The superior bite force in the implant group at both baseline and 12 weeks may be explained by several mechanisms. First, implant-supported crowns provide direct load transfer to the supporting bone without relying on adjacent abutment teeth, potentially improving mechanical stability in the restored segment. Second, clinical experience and multicenter evidence suggest that one-piece implant protocols, when properly selected and executed, can yield favorable outcomes and stable marginal bone behavior, supporting early function under controlled occlusion [12]. Our results align with this functional benefit perspective, particularly as participants were rehabilitated in bounded spaces where occlusal control and implant positioning are more predictable. Masticatory efficiency findings paralleled bite force outcomes. The two-color chewing gum test, originally developed and validated for clinical and research purposes, offers an objective assessment of mixing ability and has been widely used to compare functional outcomes across prosthetic modalities [13]. Methodological innovations, including improved software-based and colorimetric strategies, have strengthened feasibility and reproducibility of color-mixing analyses in contemporary studies [14]. In the present study, both groups showed improvement (lower mixing index) at 12 weeks, but the implant group achieved significantly better scores, implying more effective chewing cycles and improved functional comminution. The correlation analysis further demonstrated that higher bite force was associated with better masticatory efficiency, particularly in the implant cohort. This relationship is clinically intuitive: individuals who can generate greater force under stable occlusal contacts are more capable of efficient bolus breakdown and mixing during chewing. Importantly, the relationship was not perfect, suggesting that masticatory efficiency also depends on factors such as occlusal contact distribution, mandibular kinematics, and sensory feedback. When comparing our findings with prior evidence, systematic reviews have highlighted that implant-supported prostheses can enhance functional outcomes relative to conventional complete dentures and, in selected contexts, improve chewing performance; nonetheless, the magnitude of improvement can vary depending on baseline dentition status, prosthesis type, and measurement method [15]. Evidence on immediate or early functional loading of single implants indicates high success under appropriate control, supporting clinical feasibility of functional rehabilitation strategies that may translate into earlier functional gains [16-20]. While our follow-up was short-term, the consistent superiority in objective measures suggests that implant-based restoration can deliver meaningful early functional advantage in suitable cases. From a practical standpoint, conventional FPDs still demonstrated significant improvement in bite force and masticatory efficiency and remain a valid treatment choice, particularly when implants are contraindicated by anatomical, systemic, or financial constraints. However, the incremental functional benefit observed with single-piece implants—together with the tooth-preserving nature of implant therapy—may justify preference for implants in eligible patients. This is especially relevant in posterior regions where bite force demands are higher and where functional deficits are most apparent [21-26]. Limitations The study has limitations. Allocation was treatment-driven rather than randomized, which may introduce selection bias despite baseline comparability. Follow-up was limited to 12 weeks and did not assess long-term stability, prosthesis survival, marginal bone changes, or prosthetic complications that may influence functional outcomes. Finally, although color-mixing tests are validated, differences in chewing pattern and adherence to cycle instructions can add variability [21-26]. Clinical implications Within the constraints of short-term follow-up, single-piece implant-supported crowns provided higher bite force and better masticatory efficiency compared with conventional tooth-supported FPDs, indicating a potentially superior functional rehabilitation profile in bounded posterior edentulous spaces.

Both single-piece implant-supported single crowns and conventional tooth-supported fixed partial dentures produced significant improvements in maximum bite force and masticatory efficiency after a 12-week functional adaptation period. However, patients restored with single-piece implants demonstrated significantly higher bite force and superior masticatory efficiency at baseline and follow-up, along with better patient-reported chewing ability. Bite force showed a moderate negative correlation with the masticatory mixing index, indicating that stronger clenching capacity was associated with more efficient chewing performance. Clinically, these findings suggest that, in appropriately selected partially edentulous patients with bounded posterior spaces, single-piece implant restorations may provide a measurable functional advantage over conventional fixed bridges while avoiding preparation of adjacent teeth. Longer-term, randomized studies incorporating prosthesis survival, marginal bone outcomes, and broader patient-reported measures are recommended to confirm and extend these findings.

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